Page:United States Statutes at Large Volume 111 Part 1.djvu/310

 Ill STAT. 286 PUBLIC LAW 105-33 —AUG. 5, 1997 42 USC 1395W-22. "(A) shall not permit a Medicare+Choice organization to provide for cash or other monetary rebates as an inducement for enrollment or otherwise, and "(B) may include a prohibition against a Medicare+Choice organization (or agent of such an organization) completing any portion of any election form used to carry out elections under this section on behalf of any individual, "(i) EFFECT OF ELECTION OF MEDICARE+CHOICE PLAN OPTION. — " (1) PAYMENTS TO ORGANIZATIONS. —Subject to sections 1852(a)(5), 1853(g), 1853(h), 1886(d)(ll), and 1886(h)(3)(D), pay- ments under a contract with a Medicare+Choice organization under section 1853(a) with respect to an individual electing a Medicare+Choice plan offered by the organization shall be instead of the amounts which (in the absence of the contract) would otherwise be payable under parts A and B for items and services furnished to the individual. " (2) ONLY ORGANIZATION ENTITLED TO PAYMENT.— Subject to sections 1853(e), 1853(g), 1853(h), 1857(f)(2), and 1886(d)(ll), and 1886(h)(3)(D), only the Medicare+Choice organization shall be entitled to receive payments from the Secretary under this title for services furnished to the individual. " BENEFITS AND BENEFICIARY PROTECTIONS "SEC. 1852. (a) BASIC BENEFITS.— "(1) IN GENERAL.— Except as provided in section 1859(b)(3) for MSA plans, each Medicare+Choice plan shall provide to members enrolled under this part, through providers and other persons that meet the applicable requirements of this title and part A of title XI— "(A) those items and services (other than hospice care) for which benefits are available under parts A and B to individuals residing in the area served by the plan, and "(B) additional benefits required under section 1854(f)(1)(A). "(2) SATISFACTION OF REQUIREMENT.— "(A) IN GENERAL.— ^A Medicare+Choice plan (other than an MSA plan) offered by a Medicare+Choice organization satisfies paragraph (1)(A), with respect to benefits for items and services furnished other than through a provider or other person that has a contract with the organization offering the plan, if the plan provides payment in an amount so that— "(i) the sum of such payment amount and any cost sharing provided for under the plan, is equal to at least "(ii) the total dollar amount of payment for such items and services as would otherwise be authorized under parts A and B (including any balance billing permitted under such parts). (B) REFERENCE TO RELATED PROVISIONS.— For provision relating to— "(i) limitations on balance billing against Medicare+Choice organizations for non-contract providers, see sections 1852(k) and 1866(a)(l)(0), and "(ii) limiting actuarial value of enrollee liability for covered benefits, see section 1854(e).

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